Apparatuses and methods for minimizing wound dehiscense, scar spread, and/or the like

ABSTRACT

This disclosure includes apparatuses for minimizing scar spread and reducing risk of wound dehiscence and related methods. Some of the apparatuses include a flexible first strip and a flexible second strip, the first and second strips configured to be coupled to a patient&#39;s back on opposing sides of a wound and a substantially inelastic and flexible layer of material configured to be directly coupled to the first and second strips with the layer in tension to resist separation of the first and second strips, where the layer is configured to be removably coupled to at least one of the first and second strips. In some of the apparatuses, the layer is configured to be removably coupled to each of the first and second strips. In some of the apparatuses, the layer is non-removably coupled to and/or is unitary with at least one of the first and second strips.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/663,833, filed Mar. 20, 2015, which claims priority to U.S.Provisional Patent Application No. 62/043,012 filed Aug. 28, 2014, eachof which are incorporated by reference in their entirety.

BACKGROUND 1. Field of Invention

The present invention relates generally to wound care, and morespecifically, but not by way of limitation, to apparatuses and methodsfor minimizing wound dehiscence, scar spread, and/or the like.

2. Description of Related Art

Wound dehiscence may be a relatively common surgical complication andtypically occurs when a closed surgical incision breaks open or splits.For example, in a typical healing process, sutures or closuressurrounding and/or closing a wound stay intact while new tissue (e.g.,granulation tissue) forms between and/or across the wound edges.However, when wound dehiscence occurs, the wound edges can separate, andthe wound can open or split along the sutures or closures. In the eventof wound dehiscence, further surgical treatment is generally required(e.g., to treat and reclose the wound). Patients who are diabetic,obese, aged, and/or the like, or patients with relatively large or wideincisions, such as elliptical incisions, may be at an increased risk ofwound dehiscence.

To mitigate the risk of wound dehiscence, some surgeons may attempt topucker the skin around the wound during suturing. However, as the woundheals and a scar forms, the puckered and/or scar tissue may begin toflatten and spread (e.g., due to the relatively low tensile strength ofsuch tissue).

Generally, scar spread results when a post-surgical scar widens overtime. Scar tissue in high-tension areas, such as on a patient's back,shoulders, thighs, and/or the like, can be at an increased risk ofspreading. Scar spread can occur long after a wound has healed, and insome instances, may not manifest until weeks or months after a wound hashealed and/or the patient has completed follow-up treatments.

Although the skin and scar typically remain intact during scar spread,scar spread is nevertheless a serious dermatological problem. Forexample, large scars (e.g., due at least in part to size and/orappearance) are a common complaint of patients and may lead to patientdissatisfaction and distrust in the treating clinician.

Current devices designed to minimize wound dehiscence and/or scar spreadcan include sterile strips or skin adhesive. However, these devices canimpose limitations for both the patient and the clinician. For example,a clinician may not be able to adequately examine, clean, and/or treatthe wound during healing without removing the sterile strips or skinadhesive, and once these devices are removed, they must typically bedisposed of and replaced. Additionally, these devices may hinder otherwound treatments, such as the application of medicaments (e.g.,antibiotics or therapeutics) to the wound.

Examples of wound enclosures are disclosed in U.S. Pat. No. 4,709,695.

SUMMARY

Some embodiments of the present wound care apparatuses are configured,through a substantially inelastic and flexible layer of materialconfigured to be directly coupled to flexible first and second stripscoupled to a patient's skin on opposing sides of a wound, to puckerand/or apply compression to the wound to minimize wound dehiscence, scarspread, and/or the like.

Some embodiments are configured, through a removable coupling (e.g., viahook-and-loop fasteners, adhesive, and/or the like) between thesubstantially inelastic and flexible layer of material and at least oneof the flexible first and second strips, to allow a clinician to removethe layer to examine, clean, treat, and/or medicate the wound, and/oradjust the pucker and/or compression applied to the wound. Someembodiments are configured, through a recouplable coupling between thesubstantially inelastic and flexible layer of material and at least oneof the flexible first and second strips, to achieve such desirablefunctionality without requiring replacement of the apparatus, strips,layer, and/or the like.

Some embodiments are configured, through a maximum thickness of thewound care apparatus that is substantially equal to a thickness of theflexible first or second strip plus a thickness of the inelastic andflexible layer of material, to allow the apparatus to be discretely wornby a patient (e.g., under a patient's clothing).

Thus, the present wound care apparatuses and methods can provide adiscrete and effective approach to minimizing wound dehiscence, scarspread, and/or the like, while still allowing for observation, cleaning,treatment, and/or the like during the wound healing process.

Some of the present apparatuses for minimizing scar spread and reducingrisk of wound dehiscence comprise a flexible first strip, a flexiblesecond strip, the first and second strips configured to be coupled to apatient's skin on opposing sides of a wound, and a substantiallyinelastic and flexible layer of material configured to be directlycoupled to the first and second strips with the layer in tension toresist separation of the first and second strips, where the layer isconfigured to be removably coupled to at least one of the first andsecond strips. In some embodiments, the apparatus has a maximumthickness that is substantially equal to a thickness of the first orsecond strip plus a thickness of the layer. In some embodiments, thelayer comprises an absorbent pad.

In some embodiments, the layer is configured to be removably coupled toeach of the first and second strips. In some embodiments, the layer isnon-removably coupled to at least one of the first and second strips. Insome embodiments, the layer is unitary with at least one of the firstand second strips.

In some embodiments, the first and second strips comprise adhesive. Insome embodiments, the layer comprises adhesive. In some embodiments, thelayer and at least one of the first and second strips comprisehook-and-loop fasteners. In some embodiments, the apparatus isconfigured such that the layer can be removed from at least one of thefirst and second strips without removing the first and second stripsfrom the patient's skin. In some embodiments, the layer is configured tobe recoupled to at least one of the first and second strips after thelayer has been removed from the at least one strip.

Some embodiments of the present methods for minimizing scar spread andreducing risk of wound dehiscence comprise coupling a flexible firststrip and a flexible second strip to a patient's skin on opposing sidesof a wound and coupling a substantially inelastic and flexible layer ofmaterial across the first and second strips such that the layer is heldin tension by the first and second strips. In some embodiments, thelayer is directly and removably coupled to at least one of the first andsecond strips. Some embodiments comprise removing the layer from atleast one of the first and second strips without removing the first andsecond strips from the patient's skin. Some embodiments compriserecoupling the layer across the first and second strips such that thelayer is held in tension by and resists separation of the first andsecond strips. Some embodiments comprise trimming at least one of thefirst strip, second strip, and layer.

Some embodiments of the present methods for minimizing scar spread andreducing risk of wound dehiscence comprise adjusting a distance betweena flexible first strip and a flexible second strip, the first and secondstrips coupled to a patient's skin on opposing sides of a wound, andcoupling an inelastic and flexible layer of material across the firstand second strips such that the layer is held in tension by and resistsseparation of the first and second strips. In some embodiments, thecoupling of the layer to at least one of the first and second strips isremovable and direct.

Some embodiments of the present methods for providing access to a woundcomprise releasing a substantially inelastic and flexible layer ofmaterial from a direct coupling with at least one of a flexible firststrip and a flexible second strip in which the layer is under tensionbetween the first and second strips, where the first and second stripsremain coupled to a patient's skin on opposing sides of the wound.

Some embodiments of the present methods comprise applying a medicamentto the wound. In some embodiments, at least a portion of the wound is onthe patient's back. In some embodiments, at least a portion of the woundis on the patient's thigh.

The term “coupled” is defined as connected, although not necessarilydirectly, and not necessarily mechanically; two items that are “coupled”may be unitary with each other. The terms “a” and “an” are defined asone or more unless this disclosure explicitly requires otherwise. Theterm “substantially” is defined as largely but not necessarily whollywhat is specified (and includes what is specified; e.g., substantially90 degrees includes 90 degrees and substantially parallel includesparallel), as understood by a person of ordinary skill in the art. Inany disclosed embodiment, the terms “substantially,” “approximately,”and “about” may be substituted with “within [a percentage] of” what isspecified, where the percentage includes 0.1, 1, 5, 10, and 20 percent.

Further, an apparatus or system that is configured in a certain way isconfigured in at least that way, but it can also be configured in otherways than those specifically described.

The terms “comprise” (and any form of comprise, such as “comprises” and“comprising”), “have” (and any form of have, such as “has” and“having”), “include” (and any form of include, such as “includes” and“including”), and “contain” (and any form of contain, such as “contains”and “containing”) are open-ended linking verbs. As a result, anapparatus that “comprises,” “has,” “includes,” or “contains” one or moreelements possesses those one or more elements, but is not limited topossessing only those elements. Likewise, a method that “comprises,”“has,” “includes,” or “contains” one or more steps possesses those oneor more steps, but is not limited to possessing only those one or moresteps.

Any embodiment of any of the apparatuses, systems, and methods canconsist of or consist essentially of—rather thancomprise/include/contain/have—any of the described steps, elements,and/or features. Thus, in any of the claims, the term “consisting of” or“consisting essentially of” can be substituted for any of the open-endedlinking verbs recited above, in order to change the scope of a givenclaim from what it would otherwise be using the open-ended linking verb.

The feature or features of one embodiment may be applied to otherembodiments, even though not described or illustrated, unless expresslyprohibited by this disclosure or the nature of the embodiments.

Some details associated with the embodiments described above and othersare described below.

BRIEF DESCRIPTION OF THE DRAWINGS

The following drawings illustrate by way of example and not limitation.For the sake of brevity and clarity, every feature of a given structureis not always labeled in every figure in which that structure appears.Identical reference numbers do not necessarily indicate an identicalstructure. Rather, the same reference number may be used to indicate asimilar feature or a feature with similar functionality, as maynon-identical reference numbers. The figures are drawn to scale (unlessotherwise noted), meaning the sizes of the depicted elements areaccurate relative to each other for at least the embodiment depicted inthe figures.

FIG. 1A is a top perspective view of a first embodiment of the presentwound care apparatuses, shown in an open configuration.

FIG. 1B is a cross-sectional side view of the embodiment of FIG. 1A,shown in a closed configuration.

FIG. 2 is a bottom perspective view of a flexible strip of theembodiment of FIG. 1A.

FIG. 3A is a top perspective view of a second embodiment of the presentwound care apparatuses, shown in an open configuration.

FIG. 3B is a cross-sectional side view of the embodiment of FIG. 3A,shown in a closed configuration.

FIG. 4A is a top perspective view of a third embodiment of the presentwound care apparatuses, shown in a partially closed configuration.

FIG. 4B is a cross-sectional side view of the embodiment of FIG. 4A,shown in a closed configuration.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

Referring now to the drawings, and more particularly to FIGS. 1A, 1B,and 2, shown therein and designated by the reference numeral 10 a is afirst embodiment of the present wound care apparatuses. In theembodiment shown, apparatus 10 a comprises a flexible first strip 14 anda flexible second strip 18 a. For example, strips 14 and 18 a areflexible in that they are configured to couple and contour to anysuitable surface on a patient's body (e.g., as a patient ambulatesand/or otherwise moves). For example, strips 14 and 18 a can eachcomprise a synthetic cloth (e.g., nylon and/or the like), natural cloth(e.g., cotton and/or the like), plastic, and/or the like. As shown,apparatus 10 a comprises two (2) flexible strips; however, otherembodiments can comprise any suitable number of flexible strips, suchas, for example, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more flexible strips.

In this embodiment, strips 14 and 18 a are configured to be coupled to apatient's skin (e.g., 22) on opposing sides of a wound (e.g., 26). Asused in this disclosure, “wound” includes, but is not limited to, a cut,incision, opening, lesion, scar and/or the like, whether closed (e.g.,with one or more sutures 30, as shown) or open.

For example, in the embodiment shown, strips 14 and 18 a each comprisean adhesive backing 34 (FIG. 2) configured to be coupled to a patient'sskin. In this embodiment, strips 14 and 18 a each comprise a protectivecover 38 configured to be coupled to and overlie at least a portion ofadhesive backing 34. As shown, protective cover 38 can be removed from(e.g., peeled away) from the adhesive backing prior to use. In this way,adhesive backing 34 can be maintained in a sterile and/or tacky stateand/or prevented from inadvertently adhering to surfaces before use.Adhesive backing 34 and/or protective covering 38 are provided only byway of example, as strips 14 and/or 18 a can be configured to be coupledto a patient's skin through any suitable structure, such as, forexample, glue, sutures, staples, and/or the like.

In the embodiment shown, apparatus 10 a comprises a substantiallyinelastic and flexible layer of material 42 a, such as, for example,comprising synthetic cloth (e.g., nylon and/or the like), natural cloth(e.g., cotton and/or the like), plastic, and/or the like. For example,in this embodiment, layer 42 a is flexible such that it can be contouredto a surface of a patient's body and/or to portions of first strip 14and/or second strip 18 a; and layer 42 a is also inelastic such that iswill substantially resist stretching. In this way, when coupled to firstand second strips 14 and 18 a (e.g., in a closed configuration, shown inFIG. 1B), layer 42 a is configured to prevent an increase of a maximumtransverse distance 46 between (e.g., separation of) the first andsecond strips (e.g., by resisting an increase of distance 46 throughtension). In the embodiment shown, maximum transverse distance 46 can beadjusted and/or set through relative placement of the first and secondstrips on the patient's skin and/or by displacing the patient's skinthrough relative movement of the first and second strips coupled to thepatient's skin (e.g., prior to coupling layer 42 a to the first andsecond strips). Maximum transverse distance 46 between first strip 14and second strip 18 a need not be uniform, and can vary along a wound(e.g., to vary puckering, compression, and/or the like applied todifferent portions of the wound).

To illustrate, a wound (e.g., 26) can be puckered and/or compressed by aclinician, strips 14 and/or 18 a can be coupled to the patient's skin onopposing sides of the wound (e.g., if not already coupled to thepatient), and layer 42 a can be coupled to the strips, thus maintainingat least the puckering and/or compression set by the clinician. In thisway, layer 42 a can provide mechanical support for the wound and/oreffectively increase the tensile strength of the wound. Thus, apparatus10 a may function to reduce loads (e.g., shear, tension, and/or thelike) applied to the wound, for example, as a patient moves, therebyminimizing the risk of wound dehiscence, scar spreading, and/or thelike.

In the embodiment shown, layer 42 a, due in part its flexibility, isconfigured to generally permit a decrease in transverse distance betweenfirst strip 14 and second strip 18 a (e.g., in a buckling and/or foldingfashion). In this way, the wound and/or skin surrounding the wound isallowed a limited degree of movement, within the bounds of maximumtransverse distance 46.

In this embodiment, layer of material 42 a is configured to be directlycoupled (e.g., without any intervening strips, layers, other components,and/or the like) to first strip 14 and second strip 18 a (FIG. 1B). Inthis way, any tensile forces experienced by apparatus 10 a can besubstantially borne by layer 42 a. In the embodiment shown, such directcoupling can be facilitated by engagement of hook-and-loop fasteners 50a, 50 b (e.g., loops 50 a and hooks 50 b, collectively referred to ashook-and-loop fasteners) disposed on layer 42 a and at least one of thefirst and second strips (e.g., both strips, in this embodiment).However, in other embodiments, such direct coupling can be accomplishedthrough any suitable structure, such as, for example, adhesive,interlocking features disposed on layer 42 a, first strip 14, secondstrip 18 a, and/or the like. In some embodiments, described below, thelayer may be non-removably coupled to and/or unitary with one or moreflexible strip(s).

As shown, in this embodiment, one (1) layer 42 a is configured todirectly couple to and substantially overlie both first strip 14 andsecond strip 18 a (e.g., to provide maximum mechanical support, woundcoverage and/or protection, and/or the like). However, other embodimentscan comprise any suitable number of layer(s), and the layer(s) cancomprise any suitable size, shape, configuration, and/or the like, andneed not be identical to one another. For example, in this embodiment,layer 42 a, first strip 14, second strip 18 a, and/or the like can betrimmed to any suitable shape (e.g., with scissors). Through size,shape, relative placement, configuration, and/or the like of thestrip(s) and/or layer(s), the present wound care apparatuses can providefor varying degrees of airflow, applied tension, coverage, and/or thelike to a wound, and these characteristics can be varied along thewound.

As illustrated by the depicted embodiment, the present wound careapparatuses can be configured to have a relatively slim profile, suchthat, for example, they can be discretely worn by a patient (e.g., underthe patient's clothing). Such functionality can be achieved and/orfacilitated by the direct coupling (e.g., lack of intervening strips,layers, other components, and/or the like) between layer 42 a and strips14 and 18 a. For example, in this embodiment, apparatus 10 a has amaximum thickness 54 that is substantially equal to a thickness 58 ofthe first and/or second strip plus a thickness 62 of the layer.

In the embodiment shown, layer 42 a is configured to be removablycoupled to at least one of first strip 14 and second strip 18 a (e.g.,in this embodiment, to each strip such that layer 42 a can be completelydecoupled from both strips). In the depicted embodiment, layer 42 a canbe removed from at least one of first strip 14 and second strip 18 awithout removing the strips from the patient's skin. For example, thestrength of the direct coupling between layer 42 a and strips 14 and/or18 a is sufficiently large to hold layer 42 a under tension (asdescribed above), but small enough to allow decoupling of layer 42 afrom the strips without overcoming the coupling between the strips andthe patient's skin. In this way, layer 42 a can be removed to access thewound to examine, clean, treat, and/or medicate the wound, and/or adjustthe pucker and/or compression applied to the wound, and/or the like,without requiring reapplication or replacement of strips 14 and/or 18 a.

In the depicted embodiment, layer 42 a is configured to be recoupled toat least one of the first and second strips after the layer has beenremoved from the at least one strip (e.g., via hook-and-loop fasteners50 a, 50 b, reusable adhesive, reapplication of adhesive, and/or thelike). In this way, layer 42 a can be removed to access the wound toexamine, clean, treat, and/or medicate the wound, and/or adjust thepucker and/or compression applied to the wound, and/or the like asnecessary (e.g., as wound healing progresses), without requiringreplacement of layer 42 a and/or strips 14 and/or 18 a (e.g., layer 42 acan be reapplied). However, in other embodiments, layer 42 a may not bereusable (e.g., may be disposable) and/or can be replaced when desired(e.g., without removing or replacing the strips adhered to the patient'sskin), for example, when the layer becomes contaminated (e.g., by bodyfluids, medicaments, and/or the like), damaged, and/or otherwiseunsuitable for continued use).

FIG. 3A and 3B depict a second embodiment 10 b of the present wound careapparatuses. Apparatus 10 b is substantially similar to apparatus 10 a,with the primary exception that layer 42 b of apparatus 10 b isnon-removably coupled to at least one of the first and second strips(e.g., second strip 18 b). In the embodiment shown, layer 42 b isunitary with (e.g., formed, at least in part, from the same piece ofmaterial as) strip 18 b. For example, in this embodiment, layer 42 b andstrip 18 b are defined by different portions of a single piece offlexible material 66 a, for example, a portion 70 a comprising anadhesive backing and an inelastic portion 74 a, respectively. In otherembodiments, the non-removable coupling of layer 42 b and flexible strip14 and/or 18 b can be accomplished through any suitable structure, suchas, for example, glue, stitching, and/or the like.

In the embodiment shown, a proximal surface of second strip 18 b (e.g.,portion 70 a) can comprise a releasable coupler (e.g., hook-and-loopfasteners, adhesive, interlocking features, and/or the like) configuredto retain layer 42 b (e.g., portion 74 a) in an open configuration,where layer 42 b is not coupled to strip 14 (e.g., such that portion 74a overlies a portion of portion 70 a, as shown). In this embodiment,layer 42 b, strip 18 b, and/or flexible material 66 a, when in the openposition, define a folded edge 78 a that is configured to face generallytowards a wound (e.g., 26).

In the embodiment shown, layer 42 b comprises an absorbent pad 82.Absorbent pad 82 can be included in any and/or all embodiments of thepresent wound care apparatuses. Absorbent pad 82 can be configured toabsorb and/or retain fluids (e.g., medicaments, body fluids, and/or thelike), facilitate protection of a wound (e.g., 26), and/or enhancepatient comfort (e.g., by cushioning any interface between layer 42 band the wound). In some embodiments, absorbent pad 82 may be replaceable(e.g., to facilitate reusability of layer 42 b).

FIG. 4A and 4B depict a third embodiment 10 c of the present wound careapparatuses. Apparatus 10 c is substantially similar to apparatus 10 b,with the primary exception that layer 42 c, strip 18 c, and/or flexiblematerial 66 b of apparatus 10 c, when in the closed position, define afolded edge 78 b configured to face generally away from a wound (e.g.,26). In this embodiment, a proximal surface of strip 18 c (e.g., portion70 b) can comprise a releasable coupler (e.g., hook-and-loop fasteners,adhesive, interlocking features, and/or the like) configured to retainlayer 42 c (e.g., portion 74 b) in a generally closed configuration,where layer 42 c is coupled to strip 14 (e.g., such that portion 74 boverlies a portion of portion 70 b, as shown).

Some embodiments of the present methods for minimizing scar spread andreducing risk of wound dehiscence comprise coupling a first flexiblestrip (e.g., 14) and a second flexible strip (e.g., 18 a, 18 b, 18 c,and/or the like) to a patient's skin (e.g., 22) on opposing sides ofwound (e.g., 26), and coupling a substantially inelastic and flexiblelayer (e.g., 42 a, 42 b, 42 c, and/or the like) across the first andsecond strips such that the layer is held in tension by the first andsecond strips. In some methods, the layer is directly and removablycoupled to at least one of the first and second strips. Some methodscomprise removing the layer from at least one of the first and secondstrips without removing the first and second strips. Some methodscomprise recoupling the layer across the first and second strips suchthat the layer is held in tension by and resists separation of the firstand second strips. Some methods comprise applying a medicament to thewound. Some embodiments comprise trimming at least one of the firststrip, second strip, and/or layer.

Some embodiments of the present methods for minimizing scar spread andreducing risk of wound dehiscence comprise adjusting a distance (e.g.,46) between a flexible first strip and a flexible second strip, thefirst and second strips coupled to a patient's skin on opposing sides ofa wound; and coupling an inelastic and flexible layer of material acrossthe first and second strips such that the layer is held in tension byand resists separation of the first and second strips.

In some methods, at least a portion of the wound is on the patient'sback. In some methods, at least a portion of the wound is on thepatient's thigh.

Some embodiments of the present methods for providing access to a woundcomprise releasing a substantially inelastic and flexible layer ofmaterial from a direct coupling with at least one of a first flexiblestrip and a flexible second strip in which the layer is under tensionbetween the first and second strips, where the first and second stripsremain coupled to a patient's skin on opposing sides of the wound.

The above specification and examples provide a complete description ofthe structure and use of illustrative embodiments. Although certainembodiments have been described above with a certain degree ofparticularity, or with reference to one or more individual embodiments,those skilled in the art could make numerous alterations to thedisclosed embodiments without departing from the scope of thisinvention. As such, the various illustrative embodiments of the methodsand systems are not intended to be limited to the particular formsdisclosed. Rather, they include all modifications and alternativesfalling within the scope of the claims, and embodiments other than theone shown may include some or all of the features of the depictedembodiment. For example, elements may be omitted or combined as aunitary structure, and/or connections may be substituted. Further, whereappropriate, aspects of any of the examples described above may becombined with aspects of any of the other examples described to formfurther examples having comparable or different properties and/orfunctions, and addressing the same or different problems. Similarly, itwill be understood that the benefits and advantages described above mayrelate to one embodiment or may relate to several embodiments.

The claims are not intended to include, and should not be interpreted toinclude, means-plus- or step-plus-function limitations, unless such alimitation is explicitly recited in a given claim using the phrase(s)“means for” or “step for,” respectively.

1. An apparatus for minimizing scar spread and reducing risk of wound dehiscence, the apparatus comprising: a flexible first strip; a flexible second strip, the first and second strips configured to be coupled to a patient's skin on opposing sides of a wound; and a substantially inelastic and flexible layer of material configured to be directly coupled to the first and second strips with the layer in tension to resist separation of the first and second strips; where the layer is configured to be removably coupled to at least one of the first and second strips.
 2. The apparatus of claim 1, where the layer is configured to be removably coupled to each of the first and second strips.
 3. The apparatus of claim 1, where the layer is non-removably coupled to at least one of the first and second strips.
 4. The apparatus of claim 3, where the layer is unitary with at least one of the first and second strips.
 5. The apparatus of any of claims 1-4, where the first and second strips comprise adhesive.
 6. The apparatus of any of claims 1-5, where the layer comprises adhesive.
 7. The apparatus of any of claims 1-6, where the layer and at least one of the first and second strips comprise hook-and-loop fasteners.
 8. The apparatus of any of claims 1-7, where the layer comprises an absorbent pad.
 9. The apparatus of any of claims 1-8, where the apparatus has a maximum thickness that is substantially equal to a thickness of the first or second strip plus a thickness of the layer.
 10. The apparatus of any of claims 1-9, where the apparatus is configured such that the layer can be removed from at least one of the first and second strips without removing the first and second strips from the patient's skin.
 11. The apparatus of any of claims 1-10, where the layer is configured to be recoupled to at least one of the first and second strips after the layer has been removed from the at least one strip.
 12. A method for minimizing scar spread and reducing risk of wound dehiscence, the method comprising: coupling a flexible first strip and a flexible second strip to a patient's skin on opposing sides of a wound; and coupling a substantially inelastic and flexible layer of material across the first and second strips such that the layer is held in tension by the first and second strips.
 13. The method of claim 12, where the layer is directly and removably coupled to at least one of the first and second strips.
 14. The method of claim 12 or 13, comprising removing the layer from at least one of the first and second strips without removing the first and second strips from the patient's skin.
 15. The method of claim 14, comprising recoupling the layer across the first and second strips such that the layer is held in tension by and resists separation of the first and second strips.
 16. The method of any of claims 12-15, comprising applying a medicament to the wound.
 17. The method of any of claims 12-16, comprising trimming at least one of the first strip, second strip, and layer.
 18. A method for providing access to a wound, the method comprising: releasing a substantially inelastic and flexible layer of material from a direct coupling with at least one of a flexible first strip and a flexible second strip in which the layer is under tension between the first and second strips; where the first and second strips remain coupled to a patient's skin on opposing sides of the wound.
 19. The method of claim 18, comprising applying a medicament to the wound.
 20. A method for minimizing scar spread and reducing risk of wound dehiscence, the method comprising: adjusting a distance between a flexible first strip and a flexible second strip, the first and second strips coupled to a patient's skin on opposing sides of a wound; and coupling an inelastic and flexible layer of material across the first and second strips such that the layer is held in tension by and resists separation of the first and second strips.
 21. The method of claim 20, where the coupling of the layer to at least one of the first and second strips is removable and direct.
 22. The method of any of claims 12-21, where at least a portion of the wound is on the patient's back.
 23. The method of any of claims 12-22, where at least a portion of the wound is on the patient's thigh. 